Provider Demographics
NPI:1255516977
Name:REGINA MEDICAL CENTER
Entity type:Organization
Organization Name:REGINA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:G
Authorized Official - Last Name:ENCK
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:651-480-4116
Mailing Address - Street 1:1175 NININGER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1056
Mailing Address - Country:US
Mailing Address - Phone:651-480-4100
Mailing Address - Fax:651-480-4490
Practice Address - Street 1:1175 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1056
Practice Address - Country:US
Practice Address - Phone:651-480-4100
Practice Address - Fax:651-480-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN20888261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC00094Medicare Oscar/Certification